The CQC has published its report on the state of health and adult social care in England for 2023/24, highlighting concerns around digital access and exclusion, issues with data quality and reporting, and the potential for tech to help promote independence, personalise support, and uphold dignity.
Following “over 250 targeted assessments” of GP practices over a six-month period from October 2023 to March 2024 identified that services “showing innovative or outstanding practice” were focused on either improving outreach to patients or improving the availability and accessibility of appointments, introducing tech to tackle known issues, improving online accessibility options, and utilising new systems for booking appointments and online consultations.
Innovations and technology were similarly found to play a role in supporting “outstanding” adult social care providers, with new technologies such as lighting and acoustic monitoring systems observed to help in the provision of personalised support, helping staff to support people whilst maintaining their privacy and dignity.
The report notes the CQC’s support of the DHSC’s Digitising Social Care Programme, which offers additional funding to care services to help them in moving toward digital record keeping. From data collected by the CQC on uptake of digital social care records, a “huge increase” is observed in the estimated percentage of providers with digital social care records, from 41 percent of services in December 2021, to 70 percent in May of 2024.
Highlighting that “poor care” and issues in access to care can often be caused by “services not being joined up, or not working well together”, the report states that the CQC found “several ICSs” were planning “significant investment” in areas such as IT systems, improving urgent and emergency care, system flow, and waiting times. It goes on to say that “some systems have identified digital transformation as a key factor in allowing health and care organisations to make the most of the information they hold and to work together.”
Data in health and adult social care
The report highlighted issues around data quality and consistency, including in maternity, where it noted “huge differences in the way trusts collect and use demographic data, particularly ethnicity data, to address health inequalities in their local population”. It commented that “without national guidelines, we are concerned that trusts have no way of efficiently evaluating if initiatives to make maternity care more equitable are driving much-needed change”.
Another challenge relates to data and analysis skills, governance and accountability, and capacity and capability in the system. The report states that among ICSs, there are “mixed views” about capabilities to address local health inequalities, and refers to the need for “better engagement” with the voluntary and community sectors in order to ensure that “seldom heard from” groups at greater risk of inequality are not excluded.
Findings suggest that access to analytical capability is a “significant challenge shared across many ICBs”, along with access to the “right types of data to support analysis of population needs”. Where additional comments were sought from respondents, these also included reflections on the challenges around getting the most out of existing data; although in two of these cases respondents mentioned “positive efforts” to better understand and use data, through establishing a specific population health intelligence unit, or attempting to procure a new data platform.
When asked which of three areas posed “the biggest challenge to progress”, 59 percent of respondents chose system capability and capacity; whilst 17 percent chose data and skills across their ICS; 7 percent chose governance, leadership and strategy; and 17 percent opted for “other”.
Looking to data quality monitoring, local authorities cited pressures on staffing and resources as constraints which affected “how proactively they monitor quality in providers”, with some relying more heavily on CQC data and inspections, “rather than gathering their own intelligence”.
On a positive note, the report’s findings showed “how safety can be improved where local systems work collaboratively”, with shared information and data improving safety in examples such as local authorities working with mental health trusts during the transition between hospitals and the community, or young people moving from child to adult services. “Several local authorities are using information portals for different professionals, which helps to speed up people’s triage by providing prompts for the right information.”
A shift towards a “more performance and data-driven culture” is also observed amongst local authorities, which the report notes requires “establishing a combination of appropriate and robust systems to support performance measurement and monitoring, quality assurance and learning from when things have gone wrong, and embedding collective problem solving”.
Digital exclusion
The report also notes the potential for digital to become a barrier for access to care. Whilst a survey in July of 2024 of 1,600 people who had accessed health and adult social care services in the past 12 months identified that “many felt that booking through online systems was a quick and efficient way to contact their practice”; it also found that “in a few cases, though, people struggled to use online systems”, finding either technical issues, or issues with using or navigating the system.
These issues were found to be “further exacerbated” where people did not have English as their first language, according to local voluntary and community sector organisations, who reported problems around using apps or systems to make appointments, read letters, or submit medical information, and a lack of trust around translation software within digital apps.
Lack of digital access also covered poor infrastructure, although the report did find some good work underway in helping to tackle this, including support for older people, refugees, and the Gypsy, Roma and Traveller community. Where this support is available, however, it noted there often remains a need for “greater flexibility and a variety of approaches” in order to engage people from all communities.
To read the report on the state of health and adult social care in England for 2023/24 in full, please click here.
The future of health and social care in England
The UK government shared plans for two reviews exploring patient safety within the health system, examining firstly the roles and remits within six organisations overseen by the Department of Health and Social Care with a “significant” impact on patient safety, with a view to making recommendations on whether a different approach could offer improvements; and secondly focusing on quality and governance.
The DHSC launched an open call for comment asking for feedback on the health service and sharing intention to “have the biggest ever conversation about the future of the NHS”. The call is open to all, including members of the public, healthcare professionals and organisations and asks participants to share experiences and opinions, with health and social care secretary Wes Streeting highlighting that the feedback will help shape the government’s work on its 10-year plan to “turn the NHS around”.
Plans to create a “more modern” NHS in which patients have increased ownership over their own medical history were also shared by the DHSC, who announced an intention for a single patient record which will bring patient health information, test results and letters together in one place through the NHS App.
In a HTN Now panel discussion on the topic of digital integrated care, we were joined by experts from across the health sector, who discussed their views on approaches to tackling challenges from an ICS perspective; new models of care and pathway transformation; the role of technology in supporting the move from reactive to proactive care; and how a system approach can accelerate preventative care.
HTN also explored new strategies for their plans in terms of digital and data, covering Leeds Teaching Hospitals (LTH) NHS Trust’s IT Strategy for 2024 – 2028, which emphasised digital as a key enabler for efficiency, service improvement and innovation; and North West London ICB’s strategic approach to integrated neighbourhood teams (INTs), with a “no wrong front door” approach undertaken which will see all services accessible digitally, via telephone or in person.
And let’s not forget the launch of HTN’s Primary Care Awards for 2024, celebrating GP practices, primary care networks, integrated care boards and suppliers who have delivered improvements in the primary care space! This awards programme provides a platform through which we aim to share innovations, case studies, collaborations and solutions which have made a difference, and shine a spotlight on the breadth of innovative thinking and hard work happening across primary care.
